Evaluating clinical outcomes and prognosis in patients with liver cirrhosis and infection

Aim. To study the clinical outcomes and prognosis of patients with liver cirrhosis and infection.

Materials and methods. A prospective observational study was conducted on 338 hospitalized patients with liver cirrhosis aged 55.00 (45.00, 63.00) years, including 189 (55.92%) men and 149 (44.08%) women. Of these, 78 (23.08%) were class A, 118 (34.91%) class B, and 142 (42.01%) class C. Statistical data analysis was performed using R programming language (version 4.5.0). The significance level α was set to 0.05. The study was registered with Clinicaltrials.gov (NCT05335213).

Results. The survival rate of patients with liver cirrhosis without infections is significantly higher than that of patients with any infection (p adj < 0.001).

During 45 months of follow-up, death occurred in 70.3% of patients with liver cirrhosis and urinary tract infection, which is significantly higher than the rate in those without infection (33.8%) (χ2 with Yates correction = 40.77, p < 0.001, Cramer’s V = 0.35).

The incidence of urinary tract infections and other infections was significantly higher in deceased patients (56.25% and 39.38%, respectively) compared to patients who continued treatment (21.71%) (p < 0.001). Patients with an unfavorable prognosis had a higher prevalence of decompensated cirrhosis and acute kidney injury (p < 0.001).

In patients with liver cirrhosis and infections, including urinary tract infections, the instantaneous risk of death at any time point was more than four times higher than in the infection-free reference group, after adjustment for sex and age (HR = 4.31; 95% CI: 2.75–6.77; p < 0.001). Furthermore, male sex was associated with a moderate but statistically significant increase in the risk of an adverse outcome (HR = 1.40; 95% CI: 1.01–1.95; p = 0.045). In patients with cirrhosis and urinary tract infection specifically, the instantaneous risk of death was also more than four times higher (HR = 4.32; 95% CI: 2.88–6.50; p < 0.001) compared to the reference group.

In patients with liver cirrhosis and infection, the expected time to an unfavorable outcome of the disease is reduced by 7.7 times.

Conclusion. The survival rate of patients with liver cirrhosis is directly related to the presence of decompensation of the disease, acute kidney injury, and infections, including urinary tract infections, all of which require careful screening and adequate treatment.

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